TABLE 6.01 MOTHERS BIRTHING IN QUEENSLAND, 2009ONSET OF LABOUR BY PLURALITY OF PREGNANCY

Onset of labour Singleton Multiple TotalNo. % No. % No. %

Spontaneous - not augmented 21,131 35.2 278 27.6 21,409 35.1 Spontaneous - augmented 13,345 22.2 86 8.5 13,431 22.0 Induced 13,504 22.5 157 15.6 13,661 22.4 No labour 12,032 20.1 487 48.3 12,519 20.5

Total(a) 60,015 100.0 1,008 100.0 61,023 100.0 (a) Includes mothers with not stated onset of labour.

Plurality of pregnancy

TABLE 6.02 MOTHERS BIRTHING IN QUEENSLAND, 2009ONSET OF LABOUR BY AGE OF MOTHER

Onset of labour Under 20 20 - 34 35 and over TotalNo. % No. % No. % No. %

Spontaneous - not augmented 1,394 41.7 16,403 36.0 3,612 29.7 21,409 35.1 Spontaneous - augmented 1,038 31.1 10,489 23.0 1,904 15.7 13,431 22.0 Induced 711 21.3 10,283 22.6 2,667 21.9 13,661 22.4 No labour 197 5.9 8,345 18.3 3,977 32.7 12,519 20.5

Total(a) 3,340 100.0 45,523 100.0 12,160 100.0 61,023 100.0 (a) Includes mothers with not stated onset of labour.

Age of mother

TABLE 6.03 MOTHERS WITH INDUCED LABOURS, QUEENSLAND, 2009 SELECTED REASON FOR INDUCTIONReason for induction Mothers with induced labour

No. %

Prolonged pregnancy 4,851 35.5 Premature rupture of membranes(a) 1,808 13.2 Psychosocial and other administrative circumstances 1,783 13.1 Hypertension complicating pregnancy (incl. pre-eclampsia and eclampsia) 1,378 10.1 Diabetes complicating pregnancy 946 6.9 Poor fetal growth 553 4.1 Previous poor obstetric history 258 1.9 Excessive fetal growth 257 1.9 Intrauterine fetal death 155 1.1 Fetal distress 118 0.9 Twin pregnancy 112 0.8 Other fetal problems (includes decreased fetal movements) 110 0.8 Spurious/false labour 64 0.5 Rhesus and other isoimmunisation 15 0.1 Infection of amniotic sac and membranes 12 0.1

Total Induced Mothers 13,661 100.0 (a) Where the membranes rupture prior to the onset of labour regardless of gestation.

TABLE 6.04 BIRTHS, QUEENSLAND, 2009PRESENTATION BY PLURALITY OF PREGNANCY

Presentation Singleton Multiple TotalNo. % No. % No. %

Vertex 56,534 94.2 1,307 64.2 57,841 93.2 Face 67 0.1 4 0.2 71 0.1 Brow 79 0.1 2 0.1 81 0.1 Breech 2,404 4.0 622 30.6 3,026 4.9 Other 923 1.5 99 4.9 1,022 1.7

Total (a) 60,015 100.0 2,036 100.0 62,051 100.0 (a) Includes babies with not stated presentation.

Plurality of pregnancy

TABLE 6.05 BIRTHS, QUEENSLAND, 2009METHOD OF BIRTH BY PLURALITY OF PREGNANCY

Method of birth Singleton Multiple Total

No. % No. % No. %

Vaginal non-instrumental 34,853 58.1 478 23.5 35,331 56.9 Forceps 1,105 1.8 37 1.8 1,142 1.8 Vacuum extraction 4,435 7.4 59 2.9 4,494 7.2 LSCS 19,534 32.6 1,458 71.6 20,992 33.8 Classical CS 88 0.2 4 0.2 92 0.2

Total(a) 60,015 100.0 2,036 100.0 62,051 100.0 (a) Includes babies with not stated method of birth.

Plurality of pregnancy

TABLE 6.06 BIRTHS, QUEENSLAND, 2009METHOD OF BIRTH BY AGE OF MOTHER

Method of birth Under 20 20 - 34 35 and over TotalNo. % No. % No. % No. %

Vaginal non-instrumental 2,402 71.3 27,089 58.6 5,840 46.9 35,331 56.9 Forceps 52 1.5 923 2.0 167 1.3 1,142 1.8 Vacuum extraction 303 9.0 3,491 7.6 700 5.6 4,494 7.2 LSCS 611 18.1 14,649 31.7 5,732 46.0 20,992 33.8 Classical CS 3 0.1 62 0.1 27 0.2 92 0.2

Total(a) 3,371 100.0 46,214 100.0 12,466 100.0 62,051 100.0 (a) Includes babies with not stated method of birth.

Age of mother (years)

TABLE 6.07 BIRTHS, QUEENSLAND, 2009METHOD OF BIRTH BY PRESENTATION

Method of birth Vertex Face Brow Breech Other Total (a)

No. % No. % No. % No. % No. % No. %SingletonVaginal non-instrumental 34,207 60.5 32 47.8 13 16.5 239 9.9 358 38.8 34,853 58.1 Forceps 1,085 1.9 1 1.5 2 2.5 4 0.2 13 1.4 1,105 1.8 Vacuum extraction 4,352 7.7 3 4.5 9 11.4 - - 71 7.7 4,435 7.4 LSCS 16,853 29.8 31 46.3 55 69.6 2,121 88.2 470 50.9 19,534 32.6 Classical CS 37 0.1 - - - - 40 1.7 11 1.2 88 0.2 Total 56,534 100.0 67 100.0 79 100.0 2,404 100.0 923 100.0 60,015 100.0

MultipleVaginal non-instrumental 369 28.2 2 50.0 - - 100 16.1 6 6.1 478 23.5 Forceps 33 2.5 1 25.0 - - 2 0.3 1 1.0 37 1.8 Vacuum extraction 53 4.1 - - - - 6 1.0 - - 59 2.9 LSCS 852 65.2 1 25.0 2 100.0 512 82.3 90 90.9 1,458 71.6 Classical CS - - - - - - 2 0.3 2 2.0 4 0.2 Total 1,307 100.0 4 100.0 2 100.0 622 100.0 99 100.0 2,036 100.0

Total babies 57,841 71 81 3,026 1,022 62,051 (a) Includes births with not stated presentation.

Presentation

TABLE 6.08 BIRTHS, QUEENSLAND, 2009METHOD OF BIRTH BY METHOD OF PHARMACOLOGICAL ANALGESIADURING LABOUR/BIRTH

Method of Pharmacological Analgesia Vaginal Forceps/during labour (a) non-instrumental Vacuum Section Total

No. % No. % No. % No. %

None reported 11,008 31.2 407 7.2 10,740 50.9 22,155 35.7

At least one method 24,323 68.8 5,229 92.8 10,344 49.1 39,896 64.3 Nitrous oxide 18,861 77.5 3,459 66.2 3,120 30.2 25,440 63.8

Systemic Opioid 8,316 34.2 1,825 34.9 1,958 18.9 12,099 30.3 Epidural 5,928 24.4 3,247 62.1 3,788 36.6 12,963 32.5

Spinal 104 0.4 70 1.3 4,897 47.3 5,071 12.7 Combined Spinal-Epidural 72 0.3 43 0.8 418 4.0 533 1.3

Caudal 3 0.0 3 0.1 5 0.1 11 0.0 Other 87 0.4 23 0.4 48 0.5 158 0.4

Total (b) 35,331 100.0 5,636 100.0 21,084 100.0 62,051 100.0 (a) Reporting of multiple methods of pharmacological analgesia permitted.(b) Includes babies with not stated pharmocological anagesia.

Method of birth Caesarean

TABLE 6.09 BIRTHS, QUEENSLAND, 2009 METHOD OF BIRTH BY METHOD OF NON-PHARMACOLOGICAL ANALGESIA DURING LABOUR/BIRTH

Vaginal Forceps/non-instrumental Vacuum Section Total

No. % No. % No. % No. %

None reported 12,811 36.3 1,578 28.0 16,903 80.2 31,292 50.4

At least one method 22,519 63.7 4,058 72.0 4,181 19.8 30,758 49.6 Shower 12,138 53.9 2,162 53.3 1,975 47.2 16,275 52.9

Heat pack 10,381 46.1 1,898 46.8 2,164 51.8 14,443 47.0 Massage 7,466 33.2 1,539 37.9 1,571 37.6 10,576 34.4 Birth ball 5,518 24.5 1,182 29.1 1,181 28.3 7,881 25.6

Water immersion 2,052 9.1 340 8.4 257 6.2 2,649 8.6 TENS 621 2.8 117 2.9 132 3.2 870 2.8

Homoeopathy 830 3.7 91 2.2 120 2.9 1,041 3.4 Aromatherapy 396 1.8 115 2.8 92 2.2 603 2.0

Acupuncture 27 0.1 5 0.1 9 0.2 41 0.1 Other 3,125 13.9 830 20.5 695 16.6 4,650 15.1

Total(b) 35,331 100.0 5,636 100.0 21,084 100.0 62,051 100.0 (a) Reporting of multiple methods of non-pharmacological analgesia permitted.

(b) Includes babies with not stated non-pharmocological anagesia.

Method of birthPharmacological Analgesia during Labour (a)

Caesarean

TABLE 6.10 BIRTHS, QUEENSLAND, 2009 METHOD OF BIRTH BY METHOD OF ANAESTHESIA DURING LABOUR/BIRTH

Method of Anaesthesia Vaginal Forceps/for birth (a) non-instrumental Vacuum Section Total

No. % No. % No. % No. %

None reported 29,956 84.8 2,202 39.1 - - 32,158 51.8

At least one method 5,375 15.2 3,434 60.9 21,084 100.0 29,893 48.2 Spinal 145 2.7 176 5.1 13,584 64.4 13,905 46.5

Epidural 3,605 67.1 2,261 65.8 3,791 18.0 9,657 32.3 Combined Spinal-Epidural 49 0.9 46 1.3 2,846 13.5 2,941 9.8

Local to perineum 1,617 30.1 1,061 30.9 29 0.1 2,707 9.1 General Anaesthesia 48 0.9 15 0.4 1,425 6.8 1,488 5.0

Pudendal 59 1.1 172 5.0 13 0.1 244 0.8 Caudal 4 0.1 5 0.2 1 - 10 0.0

Other 14 0.3 6 0.2 67 0.3 87 0.3

Total(b) 35,331 100.0 5,636 100.0 21,084 100.0 62,051 100.0 (a) Reporting of multiple methods of anaesthesia permitted.(b) Includes babies with not stated method of analgesia/anaesthesia.

Method of birthCaesarean

TABLE 6.11 MOTHERS BIRTHING BY PRIMARY CAESAREAN SECTION, QUEENSLAND, 2009 LABOUR STATUS BY REASON FOR CAESAREANReason forCaesarean Section No labour Labour Total

No. % No. % No. %

Uterine inertia (inc failure to progress) - - 2,305 37.2 2,305 20.7 Fetal distress and/or meconium liquor 173 3.5 1,838 29.7 2,011 18.0 Breech 994 20.0 448 7.2 1,442 12.9 Unspecified psychosocial circumstances 910 18.3 106 1.7 1,016 9.1 Placenta praevia with or without haemorrhage, abruptio placentae and other antepartum haemorrhage 402 8.1 127 2.1 529 4.7

Hypertension complicating pregnancy includes pre-eclampsia and eclampsia 341 6.9 44 0.7 385 3.5 Previous poor obstetric history 311 6.3 36 0.6 347 3.1 Cephalopelvic disproportion 136 2.7 210 3.4 346 3.1 Failed medical and/or surgical induction of labour 276 5.6 18 0.3 294 2.6 Multiple pregnancy 157 3.2 65 1.1 222 2.0 Poor fetal growth 119 2.4 7 0.1 126 1.1

Total 4,966 100.0 6,196 100.0 11,162 100.0 Note: Excludes Born Before Arrival (BBA).

Labour status

TABLE 6.12 BIRTHS, QUEENSLAND, 2009ONSET OF LABOUR BY METHOD OF BIRTH

Vaginal Forceps/Onset of labour non-instrumental Vacuum Section Total

No. % No. % No. % No. %

Spontaneous - not augmented 16,914 47.9 1,370 24.3 3,389 16.1 21,673 34.9 Spontaneous - augmented 9,229 26.1 2,250 39.9 2,061 9.8 13,540 21.8 Induced 9,188 26.0 2,016 35.8 2,614 12.4 13,818 22.3 No labour - - - - 13,017 61.7 13,017 21.0

Total(a) 35,331 100.0 5,636 100.0 21,084 100.0 62,051 100.0 (a) Includes births with not stated onset of labour.

Method of birthCaesarean

TABLE 6.13 TERM (a), SINGLETON BIRTHS WITH A VERTEX PRESENTATION TO PRIMIPAROUS MOTHERS AGED BETWEEN 20 AND 34 IN PUBLIC ACCOMMODATION, QUEENSLAND, 2009 ONSET OF LABOUR BY METHOD OF BIRTH

Vaginal Forceps/Onset of labour non-instrumental Vacuum Section Total

No. % No. % No. % No. %Spontaneous - not augmented 2,757 46.3 473 24.3 358 14.9 3,588 34.8 Spontaneous - augmented 1,884 31.6 875 44.9 814 33.9 3,573 34.7 Induced 1,319 22.1 601 30.8 895 37.2 2,815 27.3 No labour - - - - 337 14.0 337 3.3

Total 5,960 100.0 1,949 100.0 2,404 100.0 10,313 100.0Note: Excludes Born Before Arrival (BBA).(a) Includes babies born between 37 and 41 completed gestational weeks.

Method of birthCaesarean

TABLE 6.14 MOTHERS WITH A PREVIOUS CAESAREAN SECTION OR OTHER UTERINE SURGERY, QUEENSLAND, 2009 METHOD OF BIRTH BY ONSET OF LABOUR(a)

Vaginal Forceps/Onset of labour non-instrumental Vacuum Section Total

No. % No. % No. % No. %

Spontaneous - not augmented 760 54.1 115 46.2 1,308 14.3 2,183 20.2 Spontaneous - augmented 404 28.8 96 38.6 204 2.2 704 6.5 Induced 241 17.2 38 15.3 106 1.2 385 3.6 No labour - - - - 7,556 82.4 7,556 69.8

Total 1,405 100.0 249 100.0 9,174 100.0 10,828 100.0 (a) For mutliple births, the method of birth of the first born baby was used.

Method of birthCaesarean

TABLE 6.15 MOTHERS BIRTHING IN QUEENSLAND, 2009 SELECTED LABOUR AND BIRTH COMPLICATIONSComplication(a) Mothers

No. %

Precipitate labour 15,100 24.8 Fetal distress and/or meconium liquor 11,679 19.1 Uterine inertia (incl. failure to progress) 5,152 8.4 Previous uterine scar 3,328 5.5 Primary post-partum haemorrhage 3,179 5.2 Prolonged second stage 2,701 4.4 Obstructed labour 2,244 3.7 Cord entanglement with/without compression 1,676 2.8 Retained placenta with/without haemorrhage 698 1.1 Breech presentation 437 0.7 Maternal distress 47 0.1

All mothers 61,023 (a) Reporting of multiple complications was permitted, so numbers cannot be cumulated.

TABLE 6.16 SELECTED LABOUR AND BIRTH COMPLICATIONS, QUEENSLAND, 2009 FOLLOWING A PERIOD OF LABOUR

Vaginal Forceps/Selected complication(a) non-instrumental Vacuum Section Total

No. % No. % No. % No. %

Perineal and other genital tract trauma 15,765 44.6 2,384 42.3 14 0.2 18,163 37.0 Fetal distress and/or meconium liquor 5,147 14.6 2,937 52.1 3,168 39.3 11,252 23.0 Uterine inertia (incl. failure to progress) 110 0.3 1,604 28.5 3,438 42.6 5,152 10.5 Long labour 767 2.2 2,035 36.1 637 7.9 3,439 7.0 Primary post-partum haemorrhage 1,897 5.4 449 8.0 392 4.9 2,738 5.6 Obstructed labour 614 1.7 443 7.9 1,187 14.7 2,244 4.6 Other obstetric trauma 474 1.3 81 1.4 90 1.1 645 1.3

Total babies born after a period of labour 35,331 5,636 8,064 49,031 (a) Reporting of multiple conditions permitted, so numbers cannot be cumulated.(b) For mutliple births, the method of birth of the first born baby was used.

Method of birthCaesarean

TABLE 6.17 MOTHERS BIRTHING IN QUEENSLAND, 2009 SELECTED PROCEDURES AND OPERATIONS PERFORMED DURING PREGNANCY, LABOUR AND THE PUERPERIUMProcedures and Operations(a) Mothers

No. %

Obstetric ultrasound 60,688 99.5 Monitoring of fetal heart during labour 34,826 57.1 Amniocentesis 971 1.6 Manual removal of Placenta 778 1.3 Administration of blood and blood products 493 0.8 Female sterilisation 170 0.3 Manipulation of fetal position and presentation 169 0.3 Chorionic villus sampling(b) 145 0.2 Insertion of cervical suture 142 0.2 Surgical postpartum evacuation of uterus 133 0.2 Pelvimetry (via CT and radiographic) 2 -

Total mothers 61,023 (a) Reporting of multiple procedures was permitted so numbers cannot be cumulated.(b) May also include other diagnostic procedures on fetus.

TABLE 6.18 MOTHERS BIRTHING IN QUEENSLAND, 2009 SELECTED PUERPERIUM COMPLICATIONSComplication(a) Mothers

No. %

Disorders of the breast and/or lactation (excluding infection) 2,313 3.8 Anaemia 1,406 2.3 Venous complications 578 1.0 Hypertension complicating the puerperium 427 0.7 Puerperial pyrexia 380 0.6 Complications of obstetrical surgical wounds 301 0.5 Post-partum haemorrhage 160 0.3 Infection of genitourinary tract 115 0.2 Spinal and epidural anaesthesia induced headache 95 0.2 Infection of breast during the puerperium 31 0.1

Total mothers 61,023 100.0 (a) Reporting of multiple complications was permitted so numbers cannot be cumulated.

TABLE 6.19 MOTHERS BIRTHING VAGINALLY, QUEENSLAND, 2009 GENITAL TRACT TRAUMA BY SURGICAL REPAIR

Genital tract trauma(a) (b) Yes No TotalNo. % No. % No. %

Nil - - 11,939 59.0 11,939 29.3 Other Genital Trauma 15 0.1 - - 15 0.0 Vaginal tear with intact perineum 361 1.8 63 0.3 424 1.0 Graze only(a) 590 2.9 4,840 23.9 5,430 13.3 1st degree laceration only 3,737 18.2 3,170 15.7 6,907 17.0 2nd degree laceration only 9,774 47.7 240 1.2 10,014 24.6 3rd degree laceration only 616 3.0 - - 616 1.5 4th degree laceration only 50 0.2 - - 50 0.1 Episiotomy only 4,778 23.3 - - 4,778 11.7 Episiotomy and laceration(d) 563 2.8 - - 563 1.4

Total 20,484 100.0 20,252 100.0 40,736 100.0(a) In the case of multiple births, details of first birth are used.(b) In the case of multiple types of perineal trauma, the highest degree of trauma is used. (c) Includes surgical repair to the lower genital tract including the cervix. (d) May include episiotomies with lacerations, other trauma or labial and perineal grazes.

Surgical repair (c)

TABLE 6.20 MOTHERS BIRTHING VAGINALLY, QUEENSLAND, 2009 EPISIOTOMY BY SURGICAL REPAIR

Episiotomy(b) Yes No TotalNo. % No. % No. %

Nil 15,143 73.9 20,252 100.0 35,395 86.9 Episiotomy only 4,778 23.3 - - 4,778 11.7 Episiotomy and laceration(c) 563 2.8 - - 563 1.4

Total 20,484 100.0 20,252 100.0 40,736 100.0(a) Includes surgical repair to the lower genital tract including the cervix.(b) For mutliple births, the method of birth of the first born baby was used.(c) May include episiotomies with lacerations, other trauma or labial and perineal grazes.

Surgical repair(a)

TABLE 6.21 MOTHERS AGED BETWEEN 20 AND 34 IN PUBLIC ACCOMMODATION WITH A VAGINAL NON-INSTRUMENTAL BIRTH OF A SINGLETON TERM(a) BABY, QUEENSLAND, 2009, GENITAL TRACT(b) TRAUMA BY ACCOUCHEUR

Other Genital tract trauma(c) (d) Obstetrician Medical officer Midwife Student midwife Medical student Other Total(e)

No. % No. % No. % No. % No. % No. % No. %Primiparous mothers

Nil 8 8.8 27 7.8 606 13.2 70 8.3 20 10.2 - - 731 12.1 Other Genital Trauma - - - - 1 0.0 - - - - - - 1 0.0 Vaginal tear with intact perineum 1 1.1 6 1.7 101 2.2 15 1.8 5 2.6 - - 128 2.1 Graze only(e) 7 7.7 33 9.5 695 15.1 167 19.9 38 19.4 - - 941 15.5 1st degree laceration only 10 11.0 61 17.6 888 19.3 142 16.9 37 18.9 1 100.0 1,139 18.8 2nd degree laceration only 30 33.0 110 31.8 1,680 36.6 335 39.9 70 35.7 - - 2,225 36.7 3rd degree laceration only 1 1.1 10 2.9 158 3.4 25 3.0 4 2.0 - - 198 3.3 4th degree laceration only 1 1.1 1 0.3 13 0.3 5 0.6 - - - - 20 0.3 Episiotomy only 29 31.9 86 24.9 378 8.2 66 7.9 20 10.2 - - 579 9.6 Episiotomy and laceration(f) 4 4.4 12 3.5 71 1.6 15 1.8 2 1.0 - - 104 1.7

Total 91 100.0 346 100.0 4,591 100.0 840 100.0 196 100.0 1 100.0 6,066 100.0 Multiparous mothers

Nil 47 39.8 248 40.0 4,412 44.1 639 35.3 162 39.5 9 52.9 5,518 42.5 Other Genital Trauma - - 1 0.2 8 0.1 - - - - - - 9 0.1 Vaginal tear with intact perineum - - 6 1.0 52 0.5 6 0.3 3 0.7 - - 67 0.5 Graze only(e) 18 15.3 100 16.1 1,646 16.4 446 24.6 68 16.6 2 11.8 2,281 17.6 1st degree laceration only 14 11.9 98 15.8 1,635 16.3 308 17.0 71 17.3 4 23.5 2,130 16.4 2nd degree laceration only 26 22.0 122 19.7 1,988 19.9 359 19.8 96 23.4 2 11.8 2,594 20.0 3rd degree laceration only 1 0.9 4 0.7 90 0.9 13 0.7 2 0.5 - - 110 0.9 4th degree laceration only - - - - 2 0.0 - - - - - - 2 0.0 Episiotomy only 10 8.5 37 6.0 153 1.5 36 2.0 6 1.5 - - 242 1.9 Episiotomy and laceration(f) 2 1.7 4 0.7 31 0.3 5 0.3 2 0.5 - - 44 0.3

Total 118 100.0 620 100.0 10,017 100.0 1,812 100.0 410 100.0 17 100.0 12,997 100.0

(a) Includes babies born between 37 and 41 completed gestational weeks.(b) Lower than but not including the cervix.(c) In the case of multiple births, details of first birth are used.(d) In the case of multiple types of perineal trauma, the highest degree of trauma is used. (e) Includes mothers with not stated accoucher.(f) May include labial and perineal graze.

Accoucheur

Note: Excludes Born Before Arrival (BBA).

TABLE 6.22 MOTHERS BIRTHING IN QUEENSLAND, 2009 SELECTED ANTENATAL ULTRASOUNDS

Singleton MultipleNo. % No. % No. %

Nuchal translucency ultrasound 33,638 56.1 697 69.2 34,335 56.3 Morphology ultrasound scan 57,533 95.9 965 95.7 58,498 95.9 Assessment for chorionicity scan 2 0.0 612 60.7 614 1.0

Total Mothers 60,015 1,008 61,023

TotalPlurality of pregnancy